Individual
LISA WIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Contact information
Practice address
315 N WASHINGTON STREET, VIBORG, SD 57070-0368
(605) 326-5161
(605) 326-5734
Mailing address
131 BROADWAY ST, CENTERVILLE, SD 57014-2202
(605) 552-2020
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0374
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5833630
—
SD
Enumeration date
09/06/2006
Last updated
07/08/2007
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